scholarly journals C-reactive protein point-of-care testing in children with cough: qualitative study of GPs' perceptions

BJGP Open ◽  
2017 ◽  
Vol 1 (4) ◽  
pp. bjgpopen17X101193 ◽  
Author(s):  
Marjolein JC Schot ◽  
Berna DL Broekhuizen ◽  
Jochen WL Cals ◽  
Esther Brussee ◽  
Niek J de Wit ◽  
...  
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Point Of Care ◽  
Diagnostic Process ◽  
Communication Tool ◽  
C Reactive Protein ◽  
Structured Interviews ◽  
Acute Cough ◽  
Reactive Protein ◽  
The Impact

BackgroundPoint-of-care C-reactive protein (CRP) testing is widely accepted in Dutch general practice for adult patients with acute cough, but GPs’ perceptions of its use in children with suspected lower respiratory tract infection (LRTI) are unknown. Knowledge of these perceptions is important when considering broadening its indication to use in children.AimTo explore the perceptions of Dutch GPs of the addition of point-of-care CRP testing to the diagnostic evaluation of children, and compare these to their perceptions of use in adults.Design & settingA qualitative study in general practice in the Netherlands.MethodSemi-structured interviews were held with 11 GPs. Interviews were analysed using open coding and a thematic approach.ResultsGPs’ perceptions of the addition of point-of-care CRP testing to diagnostic process in children with suspected LRTI differ from their perceptions of this in adults. Five themes were identified: patient characteristics; vulnerability of the child; clinical presentation; availability of evidence; the impact of the procedure; and use of point-of-care CRP testing as a communication tool.ConclusionDifferences between the perceptions of using point-of-care CRP testing in children and adults need to be addressed when considering the possible implementation of this diagnostic instrument.

scholarly journals Qualitative study to explore the views of general practice staff on the use of point-of-care C reactive protein testing for the management of lower respiratory tract infections in routine general practice in England

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023925 ◽  
Author(s):  
Charlotte Victoria Eley ◽  
Anita Sharma ◽  
Donna Marie Lecky ◽  
Hazel Lee ◽  
Cliodna Ann Miriam McNulty
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Point Of Care ◽  
Easy Access ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Practice Staff ◽  
Reactive Protein ◽  
Tract Infections

ObjectivesTo explore the knowledge, skills, attitudes and beliefs of general practice staff about C reactive protein (CRP) point-of-care tests (POCTs) in routine general practice and associated barriers and facilitators to implementing it to improve the management of acute cough.DesignA qualitative methodology including interviews and focus groups using the Com-B framework to understand individuals’ behaviour to implement CRP POCT in routine general practice. Data were analysed inductively and then aligned to the Com-B framework.SettingA service evaluation of CRP POCT over a 6-month period was previously conducted in randomly selected GP practices from a high prescribing National Health Service Clinicial Commissioning Groups in England. All 11 intervention practices (eight accepting CRPs; three declining CRPs) and the eight control practices, which were not offered CRP POCT, were also invited to interview. A further randomly selected practice not allocated to intervention or control was also invited to participate.ParticipantsSeven of eight accepting CRP, one of three declining CRP and four of nine control practices consented to participate. 12 practices and 26 general practice staff participated; 11 interviews, 3 focus groups and 1 hand-written response.ResultsParticipants reported that CRP POCT can increase diagnostic certainty for acute cough, inform appropriate management, manage patient expectations for antibiotics, support patient education and improve appropriate antibiotic prescribing. Reported barriers to implementing CRP POCT included: CRP cost, time, easy access to the POCT machine and effects on clinical workflow. Participants with greater CRP use usually had a dedicated staff member with the machine located in their consultation room.ConclusionsCRP POCT can help general practice staff improve patient care and education if incorporated into routine care, but this will need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable machines. In addition, funding will be needed to support test costs and staff time.

Point-of-care testing for C-reactive protein in acute cough presentations in primary care

2020 ◽  
Vol 12 (1) ◽  
pp. 1-7
Author(s):  
Simon Searle-Barnes ◽  
Peter Phillips
Keyword(s):  
Primary Care ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Reactive Protein ◽  
The United Kingdom ◽  
Viral Aetiology ◽  
Prescription Rates ◽  
The Uk

Acute cough is one of the most common illnesses in the UK, with an estimated 48 million cases per annum. The majority of these presentations are thought to be of viral aetiology and self-limiting in nature, yet some studies report antibiotic prescription rates of approximately 65% in the UK. Clincians' decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. This article will consider the feasibility, efficacy, benefits and limitations of using point-of-care testing of C-reactive protein within primary care in the United Kingdom to help inform management of acute cough.

scholarly journals Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101600 ◽  
Author(s):  
Marjolein JC Schot ◽  
Ann Van den Bruel ◽  
Berna DL Broekhuizen ◽  
Jochen WL Cals ◽  
Eveline A Noteboom ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

BackgroundOverprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.AimTo assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.Design & settingAn open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.MethodChildren between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.ResultsThere was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.ConclusionIt is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

C-reactive protein point-of-care testing in acutely ill children: a mixed methods study in primary care

2016 ◽  
Vol 101 (4) ◽  
pp. 382-386 ◽  
Author(s):  
Ann Van den Bruel ◽  
Caroline Jones ◽  
Matthew Thompson ◽  
David Mant
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Qualitative Study ◽  
Point Of Care ◽  
Mixed Methods Study ◽  
Contributory Factor ◽  
Antibiotic Prescribing ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Reactive Protein

BackgroundPoint-of-care C-reactive protein (CRP) testing of adults with acute respiratory infection in primary care reduces antibiotic prescribing by 22%. The acceptability and impact of CRP testing in children is unknownObjectiveTo determine the acceptability and impact of CRP testing in acutely ill children.DesignMixed methods study comprising an observational cohort with a nested randomised controlled trial and embedded qualitative study.Subjects and settingChildren presenting with an acute illness to general practice out-of-hours services; children with a temperature ≥38°C were randomised in the nested trial; parents and clinical staff were invited to the qualitative study.Main outcomesInformed consent rates; parental and staff views on testing.ResultsConsent to involvement in the study was obtained for 200/297 children (67.3%, 95% CI 61.7% to 72.6%); the finger-prick test might have been a contributory factor for 63 of the 97 children declining participation but it was cited as a definite factor in only 10 cases. None of the parents or staff raised concerns about the acceptability of testing, describing the pain caused as minor and transient. General practitioner views on the utility of the CRP test were inconsistent.ConclusionsCRP point-of-care testing in children is feasible in primary care and is likely to be acceptable. However, it will not reduce antibiotic prescribing and hospital referrals until general practitioners accept its diagnostic value in children.Trial registration numberISRCTN 69736109.

scholarly journals Interrelationships Between Serum Levels of Procalcitonin and Inflammatory Markers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A264-A265
Author(s):  
Kosuke Oka ◽  
Jo Araki ◽  
Koichiro Yamamoto ◽  
Yoshihisa Hanayama ◽  
Kazuki Tokumasu ◽  
...  
Keyword(s):  
General Practice ◽  
Bacterial Infection ◽  
Clinical Setting ◽  
Inflammatory Markers ◽  
Interleukin 2 ◽  
Serum Levels ◽  
Diagnostic Process ◽  
Individual Treatment ◽  
C Reactive Protein ◽  
Reactive Protein

Abstract Various laboratory markers are utilized in general practice to detect inflammation, and procalcitonin (PCT) has also been routinely measured in many patients as a marker of bacterial infection and sepsis. An increase in PCT starts before an increase in C-reactive protein (CRP), and PCT level is useful not only for the diagnosis of bacterial infection, sepsis, as an indicator of the severity and prognosis of systemic inflammatory diseases, and is also useful for determination of the response to individual treatment. PCT is a precursor of calcitonin and PCT is not produced in a healthy state but is produced by various tissues in septic conditions. Since there are many patients with elevated levels of PCT due to nonbacterial causes, the levels of serum PCT have been apt to be used for a marker for the early detection of not only bacterial infection but also many inflammatory and/or febrile disorders including fever of unknown origin (FUO) in the clinical setting of general medicine. Here we attempted to clarify the differences and similarities of inflammatory markers for a clinical setting. We retrospectively reviewed 359 patients in whom serum PCT had been measured. According to our earlier study, the patients were categorized into 7 groups: bacterial, non-bacterial infection, non-specific inflammation, neoplasm, connective tissue disease (CTD), drug-induced diseases, and unidentified causes. Data for 332 PCT-positive cases including cases of bacterial infection (20.5%), non-specific inflammation (20.8%), neoplasm (9.9%), CTD (8.4%), and non-bacterial infection (7.2%) were used for analysis. Serum PCT level was highest in the bacterial infection group (1.94 ng/ml) followed by the non-specific inflammatory group (0.58 ng/ml) and neoplastic diseases group (0.34 ng/ml). Of note, serum PCT level was positively correlated with serum levels of C-reactive protein (R2=0.39), soluble interleukin-2 receptor (sIL-2R; R2=0.48), and ferritin, plasma level of D-dimer level and white blood cell count, whereas it was negatively correlated with serum albumin level (R2=0.27), hemoglobin concentration and platelet count. The result of the strongly positive correlation with serum level of sIL-2R suggested that an increased serum PCT level may indicate not only an inflammatory state but also a neoplastic state such as malignant lymphomas in the diagnostic process of various inflammatory disorders in a clinical setting of general practice for diagnosing febrile conditions.

scholarly journals Effects of primary care C-reactive protein point-of-care testing on antibiotic prescribing by general practice staff: pragmatic randomised controlled trial, England, 2016 and 2017

2020 ◽  
Vol 25 (44) ◽  
Author(s):  
Charlotte Victoria Eley ◽  
Anita Sharma ◽  
Hazel Lee ◽  
Andre Charlett ◽  
Rebecca Owens ◽  
...  
Keyword(s):  
Point Of Care ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Reactive Protein ◽  
General Practices ◽  
Randomised Controlled ◽  
Pragmatic Randomised Controlled Trial

Background C-reactive protein (CRP) testing can be used as a point-of-care test (POCT) to guide antibiotic use for acute cough. Aim We wanted to determine feasibility and effect of introducing CRP POCT in general practices in an area with high antibiotic prescribing for patients with acute cough and to evaluate patients’ views of the test. Methods We used a McNulty–Zelen cluster pragmatic randomised controlled trial design in general practices in Northern England. Eight intervention practices accepted CRP testing and eight control practices maintained usual practice. Data collection included process evaluation, patient questionnaires, practice audit and antibiotic prescribing data. Results Eight practices with over 47,000 patient population undertook 268 CRP tests over 6 months: 78% of patients had a CRP < 20 mg/L, 20% CRP 20–100 mg/L and 2% CRP > 100 mg/L, where 90%, 22% and 100%, respectively, followed National Institute for Health and Care Excellence (NICE) antibiotic prescribing guidance. Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%) and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results and reduced unnecessary antibiotic use. Intervention practices had an estimated 21% reduction (95% confidence interval: 0.46–1.35) in the odds of prescribing for cough compared with the controls, a non-significant but clinically relevant reduction. Conclusions In routine general practice, CRP POCT use was variable. Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance.

Sign in / Sign up

Export Citation Format

Share Document